If you missed the first post in this series on healing chronic back pain, check it out here.

So yeah, I did a lot of physical therapy for my chronic low back pain, and it didn’t help. Not a bit. Now I think I know why. It’s not that the PT was bad, though now I’d do things a little differently (more about that in the next installment). The main problem was this: my muscles simply weren’t working right.

Thanks to Tim Ferris’s featuring Muscle Activation Techniques (MAT) in the 4-Hour Body, I had a plan when something shocking happened in Pilates one day.

More Weirdness from My Body

Because I’d already discovered Back Sense by this time, I was living with drastically reduced pain levels and was working to get my life back. So I took advantage of my funky alternative neighborhood and picked up Pilates. I loved it, everything about it.

Except that one day early on, my instructor put me in a lunge position and told me to push the Reformer carriage back with my right leg. I got halfway there and then . . . nothing.

“Is it too heavy?” he asked.

I was flustered. “No, it’s not that. It just . . . stopped. I can’t even feel the muscle anymore.” I tried again with even worse results. Tears stung my eyes. I knew it was silly but I felt humiliated.

He asked me to try with my left leg. No problem–the weight felt light. What on earth was going on???

“That,” he announced, is the clearest case I’ve ever seen of a non-firing muscle.”

He’d said the magic word, “non-firing.” I knew it was time to pursue MAT. I’d been curious about it before, but never motivated to book an appointment. Now I was motivated!

I immediately scheduled a session with Jim Guillory in Houston, TX, and in that first hour, I discovered that almost no muscle in my entire body was contracting correctly. If Jim put a limb into a position to prevent muscle compensation, I had zero strength.

Fortunately, Jim could do more than show me what was wrong; he also could make it right. He got to work restoring function to these muscles. I saw the results immediately. I waltzed back into my Pilates studio the next day and pounded that glute extension!

Over the following weeks, I began to notice the difference between walking with properly firing muscles and walking with “deactivated” muscles. I also noticed a major decrease in my low back pain, as well as the total resolution of a mysterious pain on the front of my right hip that no one (chiropractor, massage therapist, Rolfer, etc.) had been able to improve.

I’ve now been a MAT client for years and have no plans to give it up. Except, of course, that there aren’t any practitioners within a 5 hour radius of my new home. Nice.

So, What’s the Theory Behind MAT?

Let’s start with what a veteran physical therapist told me this August. She said that when she discovered MAT 15 years ago, finally everything made sense:

“You have two patients with identical injuries, torn ACLs. Both are highly compliant. One recovers like clockwork, the other deteriorates. Why? MAT answers that question: You can’t strengthen what you can’t recruit.”

The MAT theory, as I understand it, goes something like this:

For many reasons (overuse, trauma, poor habits, or stress) a muscle may cease to contract efficiently

Other muscles compensate for this under-functioning muscle

This produces unnatural and inappropriate forces applied to joints

Joint and muscle inflammation ensues and causes pain

Sometimes this inflammation can cause more muscles to shut down

And the cycle continues

A lot of muscle tension can be traced back to this under-functioning/over-functioning dynamic

As long as the muscle(s) doesn’t have full neuromuscular connection (i.e., the brain can’t recruit it), any attempts to strengthen it will actually lead instead to strengthening the compensating muscles. The more you strengthen them and improve their compensatory ability, the greater the muscular imbalances become (weak stays weak, strong gets stronger) and the more dysfunction and pain the patient experiences.

The person appears to get stronger, yet they don’t get better.

Oh man, tell me about it! I did all the “right” things with exercise, supervised by well-trained professionals, and with physical therapy, and all I got was this lousy t-shirt.

But How Does It Work?

Well, I’ll say this. Unlike some of my other favorite healing modalities, no one could accuse MAT of being woo woo. It’s as straight-laced as your middle school librarian.

Harrumph.

MAT specialists apply a variety of techniques to coax your nervous system and muscular system back into friendship, and your muscles into greater contracting efficiency. One technique is to use their fingers to stimulate the areas of the muscle that receive neural input. Jim says it’s a way to remind the brain that the muscle is there and available. Or something like that. I can’t pretend to understand it completely, but the difference is unreal.

One minute your muscle can’t withstand any resistance at all; the next it can.

If you have a lot of chiropractic experience, you might be thinking that your chiropractor does this. Perhaps on a small scale. I’ve had chiropractors show me that, say, my hip flexors are weak, then they do an adjustment, and it’s strong again. MAT specialists are far more skilled in muscle work than that—and they can treat the whole body and whole patterns of weakness, inflammation, and pain.

I do think that MAT and chiropractic can make a killer combination, though. Most chiropractors and chiropractic patients overlook the importance of muscular health and function in preserving correct skeletal alignment. Working with both at the same time can provide a more balanced approach.

When Other Things Interfere

Unfortunately, my MAT story isn’t cut and dried. I’m still a MAT client because, well, my muscles don’t stay activated. That’s not normal. Jim tells me that he sees this phenomenon with autoimmune conditions. Stay tuned on that one. I don’t have a diagnosis of one yet, but it’s a possibility.

(It is, however, perfectly normal to have chronically deactivating muscles if you don’t change the habits that may be leading to them. In my case, my habits are not enough to account for the muscle failure.)

What this meant for me is that for several months I saw Jim for 15 minutes per week, every week, to reactivate enough muscles to keep my inflammation levels down. It was like a weekly pain pill. Pricey but worth it. I also quit Pilates. No matter how gently I took it, every session I deactivated something. In fact, I did as little physical activity as possible to avoid triggering the deactivation patterns. (I’d change this approach now if I could do it over, but it’s the best I knew at the time.)

During pregnancy, suddenly all that changed. (Was it the hormone cocktail? The suppressed immune system?) I could work out and get stronger and use the right muscles to do it. Wow. I worked closely with Jim and a trainer at ATC to take baby steps. It was wonderful! I got much stronger and more stable during pregnancy.

But after the baby my body’s back to its old tricks, just dialed down a few notches. Even though my muscles still don’t work right and I’m actively pursuing healing for that problem, at least my pain is now minimal, a result of the third tool that I’ll share in the next installment.

The Seattle PT I mentioned above, however, tells me that MAT techniques have come even further in recent years and that a select 40 practitioners are being trained in the MATRx program, which offers more hope for chronically deactivating people like me. I’m really excited about this possibility and am praying for a way to receive these MATRx treatments! Denver, by the way, is MAT headquarters, a mere 6.5 hour drive away. I’m scheming for sure. Living with joint pain is a drag, especially when the more you exercise, the worse it gets.

That brings me to another thing…

A Word of Caution

As with NAET practitioners, one MAT specialist is not like another. I’ve had spectacular treatment and positively dismal treatment. In the latter case, a MAT fellow in Oklahoma City deactivated more muscles than he fixed. Oy. Not cool. Not cool at all.

So be forewarned. See someone who specializes in MAT, not someone who dabbles in it along with 5 other modalities. Find someone with as much experience as possible, and if you can, find someone through word of mouth or references. Barring that, be willing to shop around.

Here’s the MAT website where you can search for practitioners in your area. Note their date of training (generally, the older the better) and their level (usually the higher the better), and ask questions.

I’ve written two articles now on how I recovered fully from debilitating postpartum sexual pain (read Part 1 here and Part 2 here). Pelvic floor physical therapy was the backbone of my recovery. It’s not just for painful sex, though. A hypertonic (too-tight), dysfunctional pelvic floor can cause everything from intercourse pain to incontinence to chronic UTIs to organ prolapse.

If you have any kind of pain or dysfunction in your pelvic region, pelvic physical therapy might be able to help. For me, they were downright miraculous.

(FYI, your “pelvic floor” is the many layers of muscle that form the “bottom” of your body, stretching across your pelvic opening, holding up your organs, and controlling your orifices.)

Today, I’m sharing what pelvic floor physical therapy is like. It can sound mysterious and vaguely horrifying. Let me take away some of that mystery and horror!

I received two kinds of pelvic floor PT–pelvic floor biofeedback by a skilled technician and internal pelvic floor physical therapy from a well-trained physical therapist. (If you read my last post, you saw that the all-important second piece to my recovery puzzle was the daily physical-therapy-at-home work I did, but I’ll have to discuss all of that another day.)

When your conscious mind gets this information, you have the opportunity to connect certain sensations or feelings in the body with the live readings you see. Then you can learn to alter those readings and the physiological processes that produce them.

For example, a heart rate monitor can be used as a biofeedback device. It’s giving you real-time information (feedback) about what’s happening in your body (bio). In the case of your heart rate, you are already consciously aware of it on some level (you generally know your heart’s pounding or beating slowly), but you do not perceive slight variations or consciously control it. Your nervous system does that without your conscious mind’s interference, thankyouverymuch.

Yet, you can learn to influence your heart rate. Really! Practice watching your heart rate monitor and trying to alter your pulse. You’ll notice, perhaps, that your pulse tends to slow on the exhale and that certain feelings in the body coincide with the slower heart rate. In time you’ll learn how to re-create those feelings in your body and reduce your heart rate at will. Try it. (This comes in very handy when you’re nervous and the doctor wants to take your pulse. He may then be impressed and say, “You must be a runner!” And you just smile serenely.)

If you missed yesterday’s post, Part 1 (complete with a poem!), click here. Now, onward to the sunrise!

It’s Called Pelvic Pain

After re-reading Katy Bowman’s blog post on internal physical therapy, I spent hours online trying to find resources. Umpteen search terms later (no, “internal physical therapy” didn’t work), I finally ran across the term “pelvic pain.” That was the key. “Pelvic pain” opened up a Google gold mine. While I didn’t come across any happy endings like the one I’m writing now, I finally found the Pelvic Health & Physical Therapy Center in Houston, Texas.

I also discovered that millions of women are out there suffering with pelvic pain of one kind or another, much of it painful intercourse. This kind of pain does not always start after pregnancy and birth either; sometimes it’s spontaneous. (Sobering tidbit: The physical therapists told me that large studies have now demonstrated a link between hormonal birth control [e.g., the Pill] and spontaneous pelvic pain, and that they’ve seen this correlation in their own practice. That’s scary given the number of women out there using these forms of birth control.)

What the Physical Therapists Said

I gathered my courage and booked a first appointment with the PH&PTC, a 2.5 hour ordeal. I filled out reams of paperwork in excruciating detail about my most private experiences. I signed consent forms acknowledging that treatment could be painful. On the big day, I was so sick with shame and fear that I almost threw up in the waiting room. I excused myself to the bathroom and used an emotional acupressure technique to calm down (similar to the TAT but better for out-and-about emergency situations; I’ll share it later in the Healing for Life series). [Edited: Here’s the tapping technique I used.] Whew!

The nurse practitioner who governs the practice sat me down for a talk. What a relief. She talks to women just like me all day, every day–and helps them too. Kleenex abounded, and I took full advantage of them. My pain levels were a 10. My fears about the future were a 10. My sexual frustration was a 10.

The NP very compassionately listened to my history and my doctor’s conclusions, how I was feeling, the kind of support I had, and then shared her thoughts. She said that nerve entrapment was the least common cause of my symptoms, that she had some strong suspicions about what was really going on, and told me that I’d be working with a biofeedback specialist as well as one of their physical therapists.

I dread writing on such a personal topic, but when I was in despair over my condition, I wish I had run across a story like mine. So I break the silence. I’ve discovered over the past year that a staggering number of women suffer from sexual pain after pregnancy and childbirth.

Maybe you’re one of them.

I’m here to say that there is hope. I’m 14 months postpartum and have been fully recovered for months–and my pain was extreme.

If you haven’t had a baby yet, sit up and pay attention. Don’t get scared, just get informed. I learned along this recovery path that many factors pre-pregnancy set me up for this problem. In other words, you can do prevention work. You can also care for yourself postpartum differently than I did.

And if you will never have a baby (perhaps because you’re male) or you had a baby with zero difficulties, just keep in mind that the new mothers around you might be suffering in ways they can’t tell you. If they do tell you, I hope you’ll pass on this information.

Ready to dive in to my (very) personal life? It’s a long story, but I’ll try to make it a little fun along the way.

The Fabulous Birth

Photo by Justice Diven

I birthed our beautiful son, my first, at home with a midwife and doula. It was peaceful, quiet, and amazing. A couple years’ regular meditation practice, plus a birth pool and techniques from a HypnoBabies class, helped me deeply relax and progress quickly and easily.

Because of some concern about the baby’s heart rate at the end, I pushed him out quickly on a birthing stool (deep squatting position) and earned myself a second degree tear. I was disappointed about the tear but glad the baby was safe (with an Apgar of 9 at both readings) and overjoyed by his arrival and the amazing feat I’d just accomplished.

The midwife carefully sewed me up, and we went on our merry way. Well, not exactly. If you’ve had a damaged perineum, you know that the first couple of weeks are no joke. Overall, though, everything seemed normal, and I was in love with my son.

Photo by Justice Diven

The Uh-Oh

At my six week check up, my perineum was extremely sensitive and painful, and the scar looked a bit red and irritated. The midwife suggested I wait a couple more weeks before attempting intercourse. Darn it! But we did, and then we followed every precaution for relaxation, lubrication, and arousal. Yet the pain was excruciating. Excruciating. We waited a week and tried again. Repeat. Repeat. I’m going to get technical here. Mere insertion was excruciating. Actual intercourse was truly impossible.

What the Midwife Said

The midwife said that this was absolutely not normal and referred me to an OB-GYN to get checked out. While tearing is undesirable, it is common* and very rarely causes this problem, though she had heard of other women who had severe intercourse pain after having babies. The stories were scary. She also expressed concern that perhaps she had sewn me up too tightly. I certainly felt “too small,” and she was open to the possibility that she may have contributed to this outcome. (Stay tuned, the story takes a twist later.)

*Note: “common” does not equal biologically normal. We’ll get to that later.